Healthcare Provider Details

I. General information

NPI: 1689852865
Provider Name (Legal Business Name): ROSENBERG PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S BEVERLY GLEN BLVD #205
LOS ANGELES CA
90025-6927
US

IV. Provider business mailing address

1820 S BEVERLY GLEN BLVD #205
LOS ANGELES CA
90025-6927
US

V. Phone/Fax

Practice location:
  • Phone: 312-213-1974
  • Fax: 310-278-0098
Mailing address:
  • Phone: 312-213-1974
  • Fax: 310-278-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA92453
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID SAMUEL ROSENBERG
Title or Position: SENIOR PARTNER
Credential: M.D.
Phone: 312-213-1974